Rimini Hand Surgery and Rehabilitation Center, Italy.
Fenice Hand Surgery and Rehabilitation Team, Treviso, Italy.
Hand (N Y). 2021 Jul;16(4):474-481. doi: 10.1177/1558944719864451. Epub 2019 Jul 26.
The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient's work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest ( = .001), under maximal load ( = .0001), and in Mayo Wrist Score (MWS) ( = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (-10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the "critical" 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.
本研究旨在描述关节镜下切除舟状骨头部的技术，并评估舟状骨-大多角骨-小多角骨关节病病例的临床和影像学结果。2002 年至 2015 年，共对 17 例（男 13 例，女 4 例）患者进行了手术，平均年龄 57 岁（24-74 岁）。纳入标准为非创伤性桡侧腕部疼痛，经 4 个月保守治疗后无改善，且影像学显示存在骨关节炎。所有病例均在术前和术后采用视觉模拟评分（VAS）、腕关节活动范围（ROM）、握力和患者工作状态（Mayo 腕关节评分）进行评估。还使用了上肢残疾问卷（DASH）和患者腕/手评估问卷（PRWHE）进行评估。该技术包括通过关节镜进行 3-4mm 圆形舟状骨头部切除，同时保留舟状骨大多角骨和舟骨小多角骨韧带附着处。平均随访 24 个月后，所有患者均满意。结果显示，静息时疼痛（ =.001）、最大负荷时疼痛（ =.0001）和 Mayo 腕关节评分（MWS）（ =.0001）均有统计学显著改善。腕关节 ROM、握力、DASH 和 PRWHE 均有改善，但无统计学意义。术前桡月角（RL）X 射线测量角度平均为 17°（-10°至 35°）。术后平均值为 25°（0°-45°）。在术前影像学评估中，11 例超过“临界”15°RL 角。随访时，10 例 RL 角增加，7 例不变。这些病例均无症状。1 例观察到手背桡神经浅支的短暂神经麻痹。桡动脉背支损伤立即固定。由于舟状骨-大多角骨-小多角骨关节病，关节镜下切除舟状骨远段是一种有效且安全的技术，并发症少于开放性手术。
